MEXICO CITY – A unique strain of swine flu is the suspected killer of dozens of people in Mexico, where authorities closed schools, museums, libraries and theaters in the capital on Friday to try to contain an outbreak that has spurred concerns of a global flu epidemic. The worrisome new virus — which combines genetic material from pigs, birds and humans in a way researchers have not seen before — also sickened at least eight people in Texas and California, though there have been no deaths in the U.S.
A recombination of genetic elements from influenzas that infect different species holds the possibility of a much more deadly virus. Hybrids are bad. Some end up looking unlike any flu our immune systems have resistance to. Plus, they can contain mutations that make them especially lethal. The massive killer 1918 influenza pandemic originated in pigs. (correction: The 1918 virus probably originated in birds) That 1918 outbreak also was of type H1N1 and it killed from 2.5-5% of the world human population.
We are talking about lots of mixing.
Richard Besser, MD, the CDC's acting director, told reporters today during a press teleconference that the development is worrisome. "Our concern has grown since yesterday, based on what we've learned," he said. "We do not know if this will lead to the next pandemic, but our scientists are monitoring it and take the threat very seriously."
The swine flu A/H1N1 strain has been confirmed in one more US citizen, a child from San Diego who has recovered, raising the total number of US cases to eight, Besser said. The virus contains gene segments from four different influenza types: North American swine, North American avian, human, and Eurasian swine.
The US Centers for Disease Control and Prevention (CDC) is on the case. The CDC says this influenza does not usually infect humans.
Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza that regularly cause outbreaks of influenza among pigs. Swine flu viruses do not normally infect humans, however, human infections with swine flu do occur, and cases of human-to-human spread of swine flu viruses has been documented. See General Information about Swine Flu.
From December 2005 through February 2009, a total of 12 human infections with swine influenza were reported from 10 states in the United States. Since March 2009, a number of confirmed human cases of a new strain of swine influenza A (H1N1) virus infection in California, Texas, and Mexico have been identified. An investigation into these cases is ongoing. For more information see Human Swine Flu Investigation.
General Information about Swine Flu
Questions and answers and guidance for treatment and infection controlHuman Swine Flu Investigation
Information about the investigation of human swine flu in California
Here are CDC recommendations for reducing your risk of getting sick.
CDC acting director Dr. Richard Besser thinks the odds are against containment.
"There are things that we see that suggest that containment is not very likely," he said.
Mentally walk yourself thru how you are willing to change your lifestyle to reduce exposure to other people.
Mexico's government is trying to slow or stop the virus' spread.
The Mexican government was taking the threat seriously, shuttering schools and museums in Mexico City and canceling all government-sponsored gatherings for the weekend. More than six million children were kept out of school. Officials urged residents to avoid crowded public places like the subway and movie theaters.
If this takes off don't expect vaccines for months. If it turns out to be highly lethal consider my "workplace cocooning" proposal. If that isn't feasible for you then at least greatly reduce your physical exposure to other people and to surfaces that others touch.
Also see my previous post Influenza Like 1918 Strain Would Kill 62 Million. Let us hope this strain is not as dangerous as that.
Update: The 1918 pandemic is the standard to compare with. The H1N1 strain from 1918 killed between 50 and 100 million out of a total world population of 1.8 billion at the time. That's a range between 2.7% and 5.5%.
An estimated one third of the world's population (or ≈500 million persons) were infected and had clinically apparent illnesses (1,2) during the 1918–1919 influenza pandemic. The disease was exceptionally severe. Case-fatality rates were >2.5%, compared to <0.1% in other influenza pandemics (3,4). Total deaths were estimated at ≈50 million (5–7) and were arguably as high as 100 million (7).
The impact of this pandemic was not limited to 1918-1919. All influenza A pandemics since that time, and indeed almost all cases of influenza A worldwide (excepting human infections from avian viruses such as H5N1 and H7N7), have been caused by descendants of the 1918 virus, including "drifted" H1N1 viruses and reassorted H2N2 and H3N2 viruses. The latter are composed of key genes from the 1918 virus, updated by subsequently incorporated avian influenza genes that code for novel surface proteins, making the 1918 virus indeed the "mother" of all pandemics.
The 1918 fatality rate varied greatly in different parts of the world. How well you are fed, existing infections and diseases, access to health care, and ability to isolate oneself will all influence risk of contracting or dying once infected.
Update: Initial test results suggest Tamiflu and Relenza deliver some benefits against this new flu strain.
GlaxoSmithKline Plc’s flu treatment Relenza and Roche Holding AG’s Tamiflu appear effective against the strains of the virus the CDC has tested, the companies said.
But if you didn't stockpile in advance your odds of getting either drug now are falling rapidly every day.
Update II: Check out a Google Maps views of H1N1 swine flu spreading in humans. Note that the first map isn't actually a case map. Check out links on left.
Update III: Here is a Google map of real and suspected human H1N1 swine flu cases. This tracking by individual cases will become unwieldy in a few days. But for now it gives a good sense of how this flu is spreading.
By Randall Parker at 2009 April 24 06:32 PM Pandemic SignsThe 1918 flu had an estimated case fatality ratio of 2 -3%, not 2 - 5% of the world's population. It was bad, but not as bad as you suggest. Morevoer it was an avian virus, not a pig virus. The pigs got it from humans, not the other way around. Also, the process here is reassortment, not recombination. Right now we don't have a good handle on what is happening. You can find info and updates here: scienceblogs.com/effectmeasure as well as many other places.
revere,
Oops, I was quoting Wikipedia's page on the lethality of that pandemic.
revere,
This Plos Pathogens article puts the total dead from the 1918 pandemic at 50 million. Since in 1918 the world's population was 1.8 billion a 50 million death toll would have been 2.77% of the total.
So your claim looks wrong. I stand by Wikipedia after all.
Perhaps what you are missing is the very much higher rate of lethality in poorer countries in 1918:
The authors, led by Christopher Murray, D Phil, MD, from the Harvard Initiative for Global Health, used data from areas that have reasonably complete statistics for the period from 1915 to 1923. They compared influenza mortality with per capita income and latitude in 27 countries, 24 US states, and 9 Indian provinces. The researchers used the data to estimate excess mortality for a hypothetical pandemic in 2004, the most recent year for which per capita gross domestic product data are available. The report appears in the Dec 23 issue of The Lancet. For the 1918 pandemic, the researchers found a 31-fold difference between areas that had the lowest and highest excess mortality rates. Wisconsin's excess mortality was 0.25%, while India's Central provinces and Berar had a rate of 7.8% (7.8 extra deaths per 100 people).
"Based on years of intensive research, The Plague of the Spanish Lady vividly recounts those senventeen apocalytic weeks (October 19, 1918, through the final week of February, 1919) in which the Spanish Flu destroyed twenty million lives and affected perhaps a hundred times that number. Though the Black Death of the Middle ages took a higher toll, we, in our time, have known no greater tragedy."
From the jacket of The Plague of the Spanish Lady by Richard Collier
Consider calling your local grocery stores and asking if they have a home-delivery program. Mine has easy online ordering, and charges $7.
It saves me about an hour a week, or 52 hours per year, including driving time.
Mthson,
Online shopping is one big advantage we have that people in 1918 did not have. The big grocery store chains ought to organize online ordering and delivery if this influenza turns into a big killer.
"delivery"....
Jim,
I do not see a problem. I come home and find boxes on my front step from UPS. The delivery people do not need to come into contact with the residents.
On Pro-Med (an international infection disease monitoring mailing list), concern is expressed but I get the general impression that this flu is not significantly worse than the normal annual strains that go around. It is unusual in its makeup, and adds nausea to the usual flu symptoms, but is not nearly as virulent as H5N1 bird flu. The more modern two anti-flu medications work against it, and last year's vaccine may provide immunity since it had an H1N1 component, like the new flu.
I remember the Hong Kong Flu pandemic of 1968, and it wasn't any fun, but nothing like 1918. I suspect this one is expected to not be as bad as 1968.
Home delivery of groceries is one way of avoiding contracting this disease. I'm in the UK and I think this is a real concern despite it being thousands of miles away. I would recommend getting yourself some Tamiflu as they are saying its currently the only protection.
I bought some from www.fightflunow.com
John, why do you suspect this one wont be as bad as the pandemic in 1968? It has already infected nearly 1000 people in just a couple of days! Plus if you think about how much people travel these days across the world compared to 1968 this will faciltate the virus to spread hard and fast!!
Don't believe everything they report.
With a financial crisis erupting to the boiling point, officials everywhere need another crisis to take the heat off them. Citizens around the globe are ready to revolt. How do you squash a huge revolution? Orchestrate a situation that will strike fear and immobility to the average citizen. This is a bogus event, and even if there is some 'flu' out there, good nutrition and healthy habits will protect the average person. As a public health RN, I warn everyone to beware of any vaccines they offer. Vaccines kill more people than diseases do, and before the advent of vaccines, cancer was a rare occurrence. Staying calm and smart will keep all safe.
Pamela , it is great to hear someone speak rationally about this, every year we hear about the "Pandemic" disease that is going to kill us all, and people start talking about ridiculous things like staying home and cleaning your hands with anti bacterial soap everytime you touch something.. and the year goes by and it is another normal flu season.. nothing more , nothing less. The only reason for "pandemic flu" is to sell newspapers, in this day of modern medicine there is no such thing..
enough said.
This is not a normal flu season! The flu kills the infirmed, not young people in their 40's. Eye-Chiwawa, open your eyes.
Oh, get over yourselves.
This bug is fully responsive to known antivirals.
Nothing is going to happen. Within 4 weeks this will all be done and over with.
***
Pamela, there's no evidence vaccines kill more people than disease (quite the contrary) and there is NO link between vaccines and cancer. Sheesh.
Voice, that may well be the case. It does, however, provide an opportunity to discuss preparatory measures for the real thing.
As far as "delivery" goes, there is a trade-off between the lack of direct human contact and the increased likelihood that delivery personnel will be shedding virus due to community exposure. Some delivery personnel will be appropriately cautious about customer contact and others will not. Some strains will survive on packaging, and others will not.
@Pamela
"Vaccines kill more people than diseases do."
Ok, that's one of the most ignorant, insane things I've seen recently. And you claim to be an RN? That's terrifying.
I agree there's no need to panic. More information will come out in a few days.
But paranoid conspiracies about vaccines, cancer, and the financial crisis aren't helpful to anyone.
Look, I hate that lying weasel Obama as much as anyone and wouldn't trust him to tell me the time, but neither he nor some secret cabal is behind this. There really are dead people in Mexico killed by this new flu strain. There really is a new flu strain and we just don't know how virulent and lethal it will turn out to be. How much of a pandemic risk this is is yet to be determined.
How quickly things change.
Now it turns out the flu is *not* affected by this year's vaccine, and the CDC has announced that it has already spread too far to be contained.
It has already infected nearly 1000 people in just a couple of days!It has been cooking for weeks, not days. The first detected San Diego case was on 5 April.
Hello Alfie tried to order some @ www.fightflunow.com
In order to order you have to register, I attempted to register, it wanted my address, but there is no listing for the "United States" under country. Believe it takes a prescription here, but thought I could get around it if I ordered overseas, no luck.
If you are not aware of the link between vaccines and cancer, you are very much out of touch.
From the CDC website:
http://www.cdc.gov/vaccinesafety/concerns/archive/polio_and_cancer.htm#13
"Have research studies looked at the risk of cancer in children whose mothers received SV40-contaminated polio vaccine?
Yes, two studies concerning maternal vaccination with SV40-contaminated vaccines and risk of cancer in offspring have been conducted. Each study reported an association.
* Heinonen et al. (1973) reported a higher incidence of neural malignancies in children born to mothers who received inactivated poliovirus during pregnancy. The prospective study of over 50,000 women who were pregnant between 1959–1965 identified 24 malignancies in their children during the first 4 years of life. The rate of malignancy was about two-fold greater in children born to mothers immunized during pregnancy when compared with children born to unimmunized mothers or mothers who received influenza or OPV vaccines. Neural tumors accounted for most of the difference.
* Farwell et al. (1979) found that of 15 cases of medulloblastoma in children born in Connecticut between 1956–1962, 10 were born to mothers exposed to SV40 contaminated polio vaccine while 5 were born to mothers unexposed. Interpretation of these results, however, is hampered by the low response rates and uncertain accuracy of vaccination histories by obstetricians (Strickler et al., 1998)."
http://www.sv40foundation.org/Demanding-CI.html
Cornell on animal vaccines and sarcomas:
http://www.news.cornell.edu/releases/May97/catshots.hrs.html
Older people are now getting cancer in the smallpox vaccine sites:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1146007
J Clin Pathol. 1980 February; 33(2): 134–135.
PMCID: PMC1146007
Copyright notice
Basal cell carcinoma arising in a smallpox vaccination site.
It's a matter of risk/benefit. Hiding risk is inappropriate. There will be risk to a hastily concocted vaccine in response to an epidemic. To each their own choices regarding taking such a vaccine.
Since most of us are already vigilant I would expect us to already follow the precautions.
The next helpful step is to encourage your local news outlets to convey the importance of proper hygene to avoid spread, there isnt much else
The SV40 vaccine fiasco does not generalize "to vaccines cause cancer". The vast majority of vaccine does NOT cause cancer, prevents a large number of useless death from infectious disease.
As for the current "crisis" there's no need to panic. If this was a real pandemic already deaths would have doubled up and a variety of hospitals would already be reporting escalating patient volumes. So it ain't happenin people.
Voice of Reality,
While I hope you're right (about a pandemic that is, as you're obviously right about vaccines) the fact remains that over a period of less than two weeks this flu has infected almost fifteen hundred people (at least), with a mortality rate thus far of between five and ten percent. Add to that the fact that the CDC is saying it is impossible to contain the outbreak and I don't think anyone is overreacting by saying this is a big deal.
I'm the furthest thing from an alarmist, but this is serious. Serious enough for Mexico City to be closing schools and canceling all public events. Serious enough for the World Health Organisation to declare it a matter of grave international concern. Serious.
It's not a "crisis". ...It's a crisis.
what is missing in all these scenarios is the effect of air travel which increases the spread, and antivirals and better healthcare that decreses the spread. Some sites are claiming this will be worse than all pandemics: www.keepmyfamilysafe.com
This is a a flu, we have it every year, and yes it does kill people, as does car travel, eating fast food and not excersizing. this is NOT a crisis or even an issue, it is the flu. Every year when the flu hits everyone panics and brings up the "pandemic" effects of any disease because we now travel alot.. Get over it... all this is about is selling news, next month if asked about it you will say.... what flu?????
You display your ignorance John. The common flu doesn't kill 90 young people in the space of less than two weeks in the one city. ...Seven percent of the people who are confirmed to have been infected by this thing are dead. All of them below the age of sixty.
What's more, swine flu is usually only contractable through direct contact with pigs. This new genetic variation is going person to person. That in and of itself would make this noteworthy, even without the high mortality rate or the fact that this thing seems predisposed to attack healthy, young bodies... but then, those things are also true.
"All about selling news"??? I'm sorry John, but that is ridiculous. The government of Mexico have not decided to shut down their capital city, decimate their tourism industry and grant their President special powers of quarantine simply so as to move a few papers.
Here's some proof CDC is fully full of it.
http://www.cdc.gov/flu/keyfacts.htm, in this one, CDC states 36000 die annually from the flu.
http://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_13.pdf, however on page 16 of this file, only 753 died from the flu, the rest were from pneumonia.
its already global. expect thousands of new cases in the next 14 days (estimated incubation period.)
i pretty much suspected this when i heard it was in new york from kids on a plane. flu can survive on surfaces for hours.
i don't think it will be as bad as some people are making it out to be though. estimated mortality rate is 10ish %. in the states id expect our doctors to treat symptoms, and the mortality rate to be much lower.
take regular precautions, like washing your hand regularly, don't touch your face without washing.
something that might help is eat a raw garlic clove every day. ( just rip one off the bulb, cut it into quarters, and swallow like pills. the stuff in garlic is excreted in your lungs and is highly antimicrobial.
just my 2 cents
btw you can track cases here: http://maps.google.com/maps/ms?msa=0&msid=118241535231063390954.000468430d173dabe781b
Oh for Pete's sake!
The incubation period for influenza is 24 to 96 hours, 95% confidence interval -- So nowhere in hell is the incubation 14 days.
Mortality is not 10%. Mortality remains approximately 5% allowing for uncertainty in the denominator.
Mexico City is the air hub, so of course we are going to see a small dollop of cases worldwide and it will burn out.
Additionally, the fact that all of Mexico has decided to stay home will also cut the legs out from this.
The "Voice of reason", a person who deals in facts instead of the hype in the papers... Good to see there are still some people who still read the facts and interpret them correctly...
I think the biggest worry is that the virus will or has mutated into something more lethal than what we have seen in the states. The flu pandemic of 1918 came in three waves, each more virulent than the last, before petering out. Maybe the people dying in Mexico are ground zero for a second wave that is proving worse than the first. That it seems to be striking members of the healthiest demographic dead is cause for concern, since that was the Spanish Flu's M.O.
On the other hand, maybe the CFR in Mexico is not that much higher than usual for a flu virus, and we are only noticing so many people dying of this flu because we are looking for it. Hell, the whole thing might peter our in a week.
Mark, Yes, I'm worried about mutation.
But on the bright side this strain came at the ideal time: right at the end of the northern hemisphere temperate zone flu season. So we've got months to develop vaccines. The biggest issue in my mind: what's the vaccine production capacity at this point?
"""While I hope you're right (about a pandemic that is, as you're obviously right about vaccines) the fact remains that over a period of less than two weeks this flu has infected almost fifteen hundred people (at least), with a mortality rate thus far of between five and ten percent. ... I'm the furthest thing from an alarmist..."""
*guffaw* The flu has been around for at least a month. We don't have any really good idea as to how many people have been infected. Suggesting the actual mortality rate is 5% to 10% is pretty clearly alarmist. The international disease community has been itching for years to go into action against a flu virus and they are going to over-react on this one. Remember, these are the same people who confiscate butter knives before you board an airplane.
Ces,
1,600 suspected cases in Mexico with 152 deaths equals five to ten percent thus far. ...Am I missing something?
And no, the CDC and WHO are not the people who take butter knives away on airplanes.
Being a critical thinker is of absolutely no benefit if your criticisms are themselves the stuff of paranoid fantasy.
Ben,
I think what you're missing is the fact that only the people with the most severe symptoms were likely to seek treatment. In other words, the 1,600 suspect cases in Mexico might only be the 1,600 out of 160,000 actually infected who got so sick they went to the hospital.
Here's a report from The Guardian on one village's probably encounter with swine flu:
"A La Gloria resident who spoke to the Guardian on condition of anonymity yesterday described how illness swept through the village. "Some people started getting ill in February and an eight-month-old baby died," she said. "After that another baby died on 21 March. Suddenly most of the village got ill. It was weekend and the tiny clinic here was closed. The state health authorities then did send doctors and nurses to look after us, and give us medication. About 60% of the village were ill and we asked them what it was and they said it was a severe and atypical cold. We talked about influenza and they said that was impossible, that influenza had been eradicated from Mexico...
On 6 April it reported local officials had declared a health alert. According to its dispatch: "Sources characterised the event as a 'strange' outbreak of acute respiratory infection, which led to pneumonia in some paediatric cases. Health officials recorded 400 cases that sought medical treatment in the last week in La Gloria, which has a population of 3,000; officials indicated that 60% of the town's population, approximately 1,800 cases, has been affected."
http://www.guardian.co.uk/world/2009/apr/27/swine-flu-search-outbreak-source
2 deaths out of 1,800 is not 5 - 10%.
As I said, I think the prospect for mutation is worrisome, but I wouldn't personally worry too much about the strain that's circulating right now (and may never mutate into something worse).
Ben, Mark makes a good point. We do not know how many were infected so far in Mexico. We might get lucky on this one. I really really hope so. But it is too early to tell.
Mark, I like the competency level of those health care workers who told the people that influenza had been wiped out in Mexico. I wonder what else they say.
It's becoming very clear that this IS a easy transmission virus but the mortality is nowhere near what's been suspected. It seems to be maybe, just maybe, a shade worse than regular influenza with a different susceptibility target group.
So, yeah, once again, we get lucky and it's a good fire drill. In the wake of this we will get a ramp up of vaccine production capacity.
Randell,
See the following:
>Breaking news from WaPo:
>News Alert
>1:54 p.m. ET Thursday, April 30, 2009
>
>Obama Security Advance Team Member Has Suspected Case of Swine Flu
>A member of the security advance team for President Obama's recent trip to Mexico is suspected of having contracted swine flu.
It was stated up thread that the incubation period for influenza is 24 to 96 hours, with a 95% confidence interval.
Please consider for a moment that the POTUS is the center of one of the ten densest, and the most extensive, interpersonal networks on earth, via his thousands of contacts.
Now chew on the fact that the Washington Post reported that his security staff has just has someone test positive for the Swine Flu.
There are implications here on a number of levels starting with the thought that in the event of any sort of airborne vector Pandemic, the POTUS and most of our senior elected and appointed leadership is going to get hit first.
The Secret Service's protection of the POTUS is already called "Being inside the bubble." Now if the POTUS gets the Swine Flu, he is literally going to be "the man in the plastic bubble."
Well lets see, after a week of hype based on no facts we are suddenly hearing the experts say , " oh , maybe this is not the Big One" , as a matter of fact it is spreading much slower than we thought and it is milder than the normal flu we see every year. Wow! maybe reading the facts and ignoring the hype is not such a bad way to look at the subject, what do you think Ben? The good news is we did sell a lot of newspapers....